High vs. Low Initial Steroid Dose in Autoimmune Pancreatitis: Multicenter Cohort Study on Efficacy and Diabetes Worsening

<b>Background:</b> Steroid therapy is the first-line treatment for autoimmune pancreatitis (AIP) with high response rates, although steroids can cause adverse events (AEs), such as diabetes mellitus (DM). The optimal initial steroid dose has not been well studied, and initiating high-dose steroid treatment may cause worsening of DM. <b>Aims:</b> The aim of this study was to evaluate the effect of the initial steroid dosage on treatment efficacy and diabetes mellitus in the management of autoimmune pancreatitis. <b>Methods:</b> A total of 81 AIP patients treated with steroids were divided into two groups based on the starting steroid dosage: a high-dose group (HD group; >0.4 mg/kg) and a low-dose group (LD group; ≤0.4 mg/kg). Treatment efficacy (response rate, pancreatic volume), relapse rate, and DM worsening rate were analyzed. <b>Results:</b> Among the 81 patients, 58 received HD steroids, and 23 received LD steroids. The treatment response rate was 100% in both groups (58 vs. 23, <i>p</i> = 1), and the overall relapse rate was 29% vs. 26% (17 vs. 6, <i>p</i> = 0.79), with no significant difference. At 1 year, DM worsening occurred in 50% vs. 16% (25 vs. 3, <i>p</i> = 0.007), significantly more in the HD group. The risk factors for DM worsening were starting HD steroid treatment (OR 6.52, 95% CI 1.41-30.2, <i>p</i> = 0.01) and older age (OR 1.10 per year, 95% CI 1.01-1.19, <i>p</i> = 0.03). <b>Conclusions:</b> No significant difference in treatment efficacy was found between HD and LD steroid treatment for AIP. LD treatment may prevent DM worsening.